Dokument: Assoziation zwischen intra-prozeduraler Hypoxämie, Hypokapnie und postoperativem Delir in hospitalisierten Patienten ≥60 Jahre: Eine retrospektive Kohortenstudie
| Titel: | Assoziation zwischen intra-prozeduraler Hypoxämie, Hypokapnie und postoperativem Delir in hospitalisierten Patienten ≥60 Jahre: Eine retrospektive Kohortenstudie | |||||||
| Weiterer Titel: | Dose-dependent relationship between intra-procedural hypoxemia or hypocapnia and postoperative delirium in older patients | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=73439 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20260612-112046-7 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Ahrens, Elena [Autor] [im Online-Personal- und -Vorlesungsverzeichnis LSF anzeigen] | |||||||
| Dateien: |
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| Beitragende: | PD Dr. med. Schäfer, Maximilian Sebastian [Betreuer/Doktorvater] Prof. Dr. Neukirchen, Martin [Gutachter] Prof. Dr. Kranke, Peter [Gutachter] | |||||||
| Stichwörter: | Delir, Mechanische Beatmung, Anästhesie | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Experimentelle Studien haben gezeigt, dass eine eingeschränkte zerebrale Perfusion beim gesunden Menschen das Risiko für kognitive Dysfunktion erhöht. Es ist jedoch unklar, ob und in welchem Ausmaß dies für ältere Patienten gilt, die sich chirurgischen Interventionen in Anästhesie unterziehen, nach welcher postoperative kognitive Dysfunktion, besonders das Delir, eine häufige Komplikation darstellt. Die vorliegende Studie untersucht die Assoziation zwischen intra-prozeduraler Hypoxämie, Korrelat zerebraler Oxygenierung, und Hypokapnie, welche die Gehirnperfusion maßgeblich beeinflusst, mit dem Neuauftreten eines postoperativen Delirs. Hospitalisierte Patienten im Alter von mindestens 60 Jahren, welche sich zwischen 2009 und 2020 einer chirurgischen Intervention in Allgemeinanästhesie an einem tertiären akademischen Lehrkrankenhaus in Boston, Massachusetts, Vereinigte Staaten von Amerika, unterzogen, wurden in eine retrospektive Kohortenstudie eingeschlossen. Die primäre unabhängige Variable war eine periphere Sauerstoffsättigung von <90% für mehr als zwei konsekutive Minuten. Die sekundäre unabhängige Variable war ein end-tidaler Kohlenstoffdioxid-Partialdruck von kleiner gleich 25 mmHg für mehr als fünf konsekutive Minuten zwischen In- und Extubation. Die abhängige Variable war die Diagnose eines Delirs innerhalb der sieben unmittelbar auf den Eingriff folgenden Tage, definiert anhand von Diagnosecodes der International Classification of Diseases (9th/10th Revision, Clinical Modification) oder einem Positivbefund der Confusion Assessment Method auf der Intensivstation. 71 717 Patienten wurden in die Studienkohorte eingeschlossen. 1 702 (2.4%) entwickelten ein postoperatives Delir, während 2 532 (3.5%) Patienten intra-prozedurale Hypoxämie erlitten. Von 42 894 Patienten, die eine Allgemeinanästhesie mit maschineller Beatmung erhielten, hatten 532 (1.2%) intra-prozedurale Hypokapnie. Sowohl Hypoxämie (adjustierte Odds Ratio [ORadj] 1.71; 95% Konfidenzintervall [CI], 1.40-2.07; P<0.001) als auch Hypokapnie (ORadj 1.77; 95% CI, 1.30-2.41; P<0.001) waren unabhängige Risikofaktoren für das Neuauftreten eines Delirs innerhalb von sieben Tagen. Beide Assoziationen waren dosis-abhängig von Schweregrad und Dauer der jeweiligen Episode (ORadj 1.03; 95% CI, 1.02-1.04; P<0.001 und ORadj 1.01; 95% CI, 1.00-1.01; P=0.005, jeweils pro eine Minute in der längsten konsekutiven Episode). Hyperkapnie hingegen war nicht mit postoperativem Delir assoziiert (ORadj 1.24; 95% CI, 0.90-1.71; P=0.181). Zusammenfassend sind intra-prozedurale Hypoxämie und and Hypokapnie dauer- und schweregradabhängig mit dem Auftreten eines Delirs nach operativen Eingriffen assoziiert. Anästhesisten sollten einen normwertigen intraoperativen Gasaustausch anstreben, um das Risiko für postoperatives Delir zu minimieren.Previous experimental studies in animals and humans linked impaired cerebral perfusion to neurological dysfunction. It remains unclear whether these findings are relevant for patients undergoing anesthesia for surgery or interventional procedures, where many factors can impair cerebral perfusion and postoperative neurological dysfunction, such as postoperative delirium, is a common and devastating complication. We investigated whether intra-procedural hypoxemia, which closely correlates with tissue oxygenation, or hypocapnia, which modifies cerebral perfusion, are associated with postoperative delirium in patients of advanced age. We conducted a retrospective cohort study including hospitalized patients aged 60 years or older who underwent anesthesia for surgical or interventional procedures at an academic healthcare network in Boston, Massachusetts, United States of America, between 2009 and 2020. The primary exposure, intra-procedural hypoxemia, was defined as the occurrence of a peripheral oxygen saturation <90% for more than two cohering minutes. The co-primary exposure, hypocapnia during general anesthesia with mechanical ventilation, was defined as the occurrence of an end-tidal carbon dioxide pressure of 25 mmHg or less for more than five cohering minutes. Delirium within seven days after the index surgery, identified using previously published International Classification of Diseases (9th/10th Revision, Clinical Modification) diagnostic codes and positive Confusion Assessment Method assessments, was the primary outcome. 71,717 patients were included in the primary study cohort. 1,702 (2.4%) patients developed postoperative delirium, while hypoxemia occurred in 2,532 (3.5%) cases. 42,894 patients underwent general anesthesia with mechanical ventilation, of which 532 (1.2%) experienced hypocapnia. The occurrence of both hypoxemia (adjusted odds ratio [ORadj] 1.71; 95% confidence interval [CI], 1.40-2.07; P<0.001) and hypocapnia (ORadj 1.77; 95% CI, 1.30-2.41; P<0.001) was associated with a higher risk of delirium within seven days. Both associations were magnified with an increasing degree of hypoxemia or hypocapnia, and increased with event duration (ORadj 1.03; 95% CI, 1.02-1.04; P<0.001 and ORadj 1.01; 95% CI, 1.00-1.01; P=0.005, for each minute increase in the longest continuous episode, respectively). The occurrence of hypercapnia was not associated with postoperative delirium (ORadj 1.24; 95% CI, 0.90-1.71; P=0.181). In conclusion, intra-procedural hypoxemia and hypocapnia were dose- and magnitude-dependently associated with a higher risk of delirium after surgery. Anesthesia providers should aim to maintain normal intraoperative gas exchange to help prevent delirium after surgery or interventional procedures. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 12.06.2026 | |||||||
| Dateien geändert am: | 12.06.2026 | |||||||
| Promotionsantrag am: | 23.12.2025 | |||||||
| Datum der Promotion: | 28.05.2026 |
